Tumors and Tumor-like Abnormalities of the Midfoot and Forefoot

Abstract

The differential diagnosis for a midfoot or forefoot mass or mass-like abnormality includes several common benign and malignant pathologies. Evaluation with imaging can often provide a diagnosis, or at least several likely etiologies, and guide management. Determining if a mass is cystic or solid with ultrasound or MRI can limit the differential diagnosis. Identifying the abnormality at a specific anatomical site, such as a bursa, peripheral nerve, plantar aponeurosis, or tendon, can often suggest a correct diagnosis. Correlation with radiography is essential to determine potential osseous origin or involvement and further characterize matrix mineralization. Imaging evaluation can effectively characterize a mass or mass-like abnormality of the midfoot or forefoot, which can provide a precise or limited differential diagnosis and guide further management for biopsy or other treatment.

High-resolution ultrasound and MRI in the evaluation of the forefoot and midfoot

“…Soft tissue masses in the mid-and forefoot region are nearly always benign. The most frequently encountered masses are ganglion cyst, Morton's neuroma, gouty tophus, plantar fibroma, leiomyoma, nerve sheath tumor, lipoma, vascular malformation, tenosynovial giant cell tumor (Ts-GCT), and foreign body granuloma (20) . In most instances, US enables an accurate assessment and characterization based on imaging findings alone, without the need for percutaneous biopsy or additional imaging.…”